Beruflich Dokumente
Kultur Dokumente
Preaching?
Kelly Caverzagie, MD
Department of Internal Medicine
University of Nebraska Medical Center
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Disclosures
A portion of my salary at the University
of Nebraska is reimbursed by the ABIM:
◦ Academic Affairs
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Learning Objectives
Identify the basic principles of Competency-
Based Medical Education (CBME)
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Outline
Background review of CBME
◦ Need for meaningful assessment
Assessment of Competence
◦ Entrustable Professional Activities (EPA)
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Competency-Based Medical Education
CBME is an outcomes-based approach to
the design, implementation, assessment
and evaluation of a medical education
program using an organizing framework of
competencies.
Cardiology Consult
Research Elective
Geriatrics
Traditional vs. CBME: Start with System Needs
Frenk
Lancet, 2010
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ACGME – Outcome Project
Medical Knowledge
Patient Care and
Procedural Skills
Introduced 1999
Implemented 2001 Professionalism
Interpersonal &
6 General Communication Skills
Competencies
Practice-based Learning &
Improvement
Systems-based Practice
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IOM High Quality Care
Timely – reducing waits and harmful delay
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Medicare-Determined Outcomes
Work effectively in multiple settings
Coordinate care within and across settings
Understand cost and value of diagnostic and
treatment options
Work in inter-professional teams and multi-
disciplinary team-based models
Identify systematic errors and in implement
systematic solutions in case of errors
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Traditional vs. CBME
Educational Program
Variable Structure/Process Competency-based
Driving force: Curriculum Content Outcome
Goal of educ. encounter Knowledge acquisition Knowledge application
Typical assessment tool Single subjective measure Multiple objective measures
Assessment tool Proxy Authentic
(mimic real tasks of profession)
Setting Removed (gestalt) Direct observation
Focus of Assessment Norm-referenced Criterion-referenced
Timing of assessment Emphasis on summative Emphasis on formative
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Old Assessment System
Ambulatory Clinic
Cardiology Consult
Research Elective
Geriatrics
New Assessment
Manage multiple meds
System
Inform steps
Consult to non-medicine teams along the way to
becoming an
unsupervised
Critically appraise literature internist
Competent
◦ Passes driver’s education classes
◦ Passes driver’s exam to get the license
Competence
◦ Drives safely on interstate or during bad weather,
avoids accidents, no traffic tickets
◦ Dad gives him the keys and walks away
When do your fellows get the keys to
the car?
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Potential Criticisms
• There are too many!
◦ Programs cannot assess all of them
Reductionistic?
◦ Potential to deconstruct the learners’
performance into discreet tasks or checklists
◦ Checking off competencies does not equate
to competence
CBME Challenge
Ensure that the outcomes of the
assessment actually demonstrate
competence in the activities that define
the profession
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“Windows to Competence”
Caverzagie and Iobst
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EPA - Lead and work within
interprofessional teams
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EPA - Lead and work within
Accept feedback interprofessional teams
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EPA - Lead and work within
interprofessional teams
Manage diverse
opinions with
goal optimizing
patient care
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EPA - Lead and work within
interprofessional teams
Maintain
climate of
mutual respect
and shared
values
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EPA - Lead and work within
interprofessional teams
Engage in
collaborative
communication
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EPA - Lead and work within
interprofessional teams
Identify and
understand
roles of team
members 38
EPA - Lead and work within
Accept feedback interprofessional teams
Goals
◦ Develop ‘shared mental model’ of the EPA in
order to inform meaningful assessment
◦ Write down recommendations and provide to
________________.
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Considerations
Compare / contrast to Internal Medicine EPA’s
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Group Activity #2 - Task
Consider the entire list of Geriatric EPAs
◦ Is anything missing? Is anything redundant?
◦ Do they reflect the expected outcomes?
Profession
Patient / Public
Policy makers
Goals
◦ Hand in recommend revisions
◦ Use your expertise to guide community
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Building Assessments for an EPA
Step 1 – Describe the activity. What tasks are
required for you to entrust the fellow to do this
activity at the end of training?
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Clinical
Educational Milestones
Competency
Committee
Assessment
System
Next Accreditation
System
Learning Objectives
Identify the basic principles of Competency-
Based Medical Education (CBME)
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Thank You!
kelly.caverzagie@unmc.edu
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